Our care systems, deeply rooted in racial and gender inequities for those providing paid and unpaid care work, are in need of an overhaul. For unpaid family caregivers and the direct care workforce, the majority of whom are Black, Indigenous and people of color (BIPOC) women, revamping and reinvesting in our crumbling caregiving infrastructure means prioritizing home and community-based services, enacting a national paid family and medical leave policy, and ensuring care jobs are good jobs by providing training, education and a living wage for the direct care workforce.
We are in the midst of a long-term care crisis. The population of adults aged 65 and older will double over the next 40 years, and as this population increases, so too will their care needs. Older adults who need care may not be able to afford the out-of-pocket cost of receiving care. Private insurance may be out of reach and programs like Medicare and Medicaid are simply not enough, at times requiring older adults to impoverish themselves in order to qualify. What COVID-19 has done is made it abundantly clear that our current system of care and long-term care is unaffordable and unsustainable for many and especially for families who are BIPOC.
But the need for care will continue as will the reliance on who can provide that care; pushing many to depend on the unpaid labor and financial support of primary family caregivers and on the paid labor of direct care workers. Paying for care in congregate settings like nursing homes and adult day centers are unattainable for many families. In 2020, the annual cost of a semi-private room in a nursing home was $105,850 while the cost of assisted living facilities was $51,600. Families struggle to pay for care and often utilize a combination of savings, retirement or pension funds, or the proceeds from selling their home, to make ends meet. Barring available and affordable home and community-based services, it’s an impractical situation and as a result family caregivers take on the bulk of providing care for their loved ones. More than 34 million unpaid family caregivers are caring for family and friends over the age of 50, and a large portion are doing so without proper support or services in place.
Family caregivers face physical, emotional and financial impacts of providing care both in the short and long term. According to a recent report by AARP, caregivers report experiencing financial strains, citing the effects caregiving has on their ability to save now and for their retirement in addition to the accumulation of further debt. As the pandemic continues, families of color are being hit hard and women, who traditionally take on the responsibility of caregiving, are having to make the impossible choice between caring for themselves or a loved one and remaining in the workforce. Since the start of the pandemic, 2.1 million women have left the workforce and in December 154,000 Black women left the labor force. While the reasons for Black women and women of color leaving the workforce vary, what is clear is the profound impact having to care for a young child, an older loved one and/or support a family member with a disability has had on their ability to perform at pre-COVID-19 levels and maintain steady employment without having workplace support and policies in place that address the underlying issues and disparities Black women and women of color face.
Workplace policies like paid family and medical leave and paid sick days are vital for caregivers, for women and women of color in the workforce who are simultaneously caring for their families and others. It is also imperative for direct care workers, a sector of the healthcare labor force that is in high demand, yet these essential workers are undervalued and underpaid. Eighty-six percent of the direct care workforce is female and over half, 59%, are people of color who provide assistance to older adults and individuals with disabilities. As the number of family caregivers dwindles and the demand for care increases, we rely on this workforce to assist those with complex care needs, to assist with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
The poor quality of care jobs, low pay and little to no benefits, training or upward mobility, leaves this sector with low retention rates and high turnover. It also places the financial stability of direct care workers in peril, the majority of whom are BIPOC. As it stands, 53% of Black care workers rely on some form of public assistance compared to 34% of Black immigrant care workers and 38% of White care workers. Coupled with disparities in wages and yearly earnings according to demographic characteristics like race and ethnicity, Black direct care workers may be forced to leave the field altogether.
There is a workforce shortage and in order to ensure the growing care demands are met, we need policies and solutions that make care jobs good jobs. We need significant investments in our care systems and in our direct care workforce and it starts by valuing the work and valuing the workers. It’s time to care about the ones providing the care so they don’t drift further into poverty. Establishing national paid family and medical leave and increasing wages is a good start point, as is recognizing the inequalities Black care workers encounter which places them at a disadvantage relative to their White counterparts.
To support BIPOC women in our care systems, we need to re-envision how we view care while acknowledging the systemic barriers and disadvantages they encounter as paid care workers and unpaid family caregivers and center their narratives when reconstructing our systems of care. We need significant investments in building up our communities and people so BIPOC have access to affordable healthcare and services that would allow them to age with dignity and care for themselves and their families.